The Philippine Online Chronicles

Some people have little rituals that they observe. A person may like taking the longer yet scenic route going to work, cleaning his shoes everyday or organizing a collection of books according to size.  These trivial ceremonious acts are generally harmless.

However, some people’s actions involve excessive repeated behavior, unnecessary actions and weird urges that can disrupt lives.

In the 1997 movie As Good As It Gets, actor Jack Nicholson portrays Melvin Udall, an eccentric character who likes doing odd things like washing his hands repeatedly in hot water using a fresh bar of soap. He avoids contact with things that he thinks are germ ridden, using gloves to touch things in public places, insisting on staying on the same table at a restaurant and bringing own plastic utensils when dining in that place. Melvin also has a habit of locking his front door several times in a row; turning the lights on and off in a repeated manner and walking around cracks in the street.

To a normal person, the strange things he does are making his life complicated and more difficult. However, for Melvin, these things bring him a sense of comfort and security. In the movie, Melvin is diagnosed by his psychotherapist to be suffering from a condition called obsessive -compulsive disorder (OCD).

Based on community studies, it is estimated that between 1 and 3 percent of the population have OCD. In the United Sates alone, about 2.3% are suffering from OCD. It means that 1 in every 43 Americans are affected in the USA.

OCD cases in the Philippines

Many Filipinos casually use the term ‘obsessive-compulsive’ or ‘OC’ to describe a very organized and meticulous person.  Despite the common use of such term, it must not be confused with the clinical obsessive-compulsive disorder.

Fixation on certain things like cleanliness, orderliness and doing things to avoid diseases may not necessarily be traits of OCD. Some people may just be perfectionists or exhibit overly concern about some things.

Based on the publication ‘Statistics by Country for Obsessive-Compulsive Disorder’ by the group Cure Research, it is estimated 1,046,314 million people in the Philippines are affected by the disorder.  However, this figure is merely a projection and not the actual statistic of OCD cases in the country.  A lot of individuals still remain undiagnosed because they are not aware of their condition or ashamed of seeking medical help due to fear of being labelled crazy.   There are a lot of people with OCD who need help.

What is OCD?

Obsessive-compulsive disorder (OCD) is a type of anxiety disorder which causes people to have obsessions and compulsions.  Anxiety disorder is associated with a very high level of tension or worry. OCD equally affects both men and women.  It can manifest in childhood, adolescence or early adulthood.

Obsessions are repeated thoughts, urges, images and impulses that preoccupy an individual’s mind. Obsessions seem senseless and distressing.  It is not a simple matter of worrying excessively about real-life problems. The person has difficulty ignoring or suppressing the obsessions in his mind. The individual has tremendous difficulty controlling the disturbing ideas and thoughts which often affects his daily activities.

Compulsions are repeated behaviors or mental acts that a person feels compelled to do. Obsessive thoughts cause nervousness and anxiousness on a person with OCD. The person performs certain acts in order to prevent or reduce distress caused by obsessive thoughts.  The repeated behaviors are not for the purpose of pleasure. In most cases, the person feels the urge to perform certain behaviors to reduce anguish caused by an obsession.

Melvin has obsessive fear of germs. His thoughts compel him to wash his hands repeatedly and thoroughly. He throws away the soap after using it once. The fear of germs invading his body is set aside after a satisfactory hand washing routine.  When the fear returns, Melvin feels the urge to wash his hands all over again.

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Common obsessions and compulsions

• Scared of dirt or germs
• Dread of bodily waste or fluids
• Overly concerned with order and balance (symmetry) of things
• Worry that a task was not fulfilled properly despite knowing the contrary
• Fear of bad or sinful thoughts
• Preoccupation with thoughts about certain sounds, images, words or numbers
• Craving for constant reassurance
• Afraid of harming a family member or friend

The following are some common compulsions:

• Excessive washing of hands, showering, brushing teeth and cleaning
• Repeatedly checking door locks, furniture and appliances to make sure they have been properly closed or turned off
• Repeating actions such as turning on and turning off the lights, going in and out of a door, sitting down and getting up from a chair, or touching specific objects several times
• Organizing or lining up items in certain ways
• Counting to a certain number over and over again
• Not discarding old newspapers, mail or containers even though they are no longer needed
• Seeking for constant approval and reassurance

Other health conditions linked with OCD

Some people who suffer from OCD may also suffer from other types of anxiety such as phobias (e.g. fear of spiders, fear of height, fear of flying, etc.) and panic attacks. Some individuals with OCD may also exhibit signs of depression, attention deficit hyperactivity disorder (ADHD), eating disorder or a learning disorder such as dyslexia.

Multiple disorders can make diagnosis and treatment more complicated. It is vital for the patient to be honest with his doctor about any symptom that can point to a certain disorder.

Treatment options

A person suspected to have OCD can be diagnosed by a qualified psychiatrist, psychologist or therapist.  Diagnosis involves determining symptoms and ruling out possibility of other mental problems and anxiety disorders.  Below are just two examples of treatment for OCD cases.

Therapy combined with medication is usually considered the most effective treatment for OCD. A trained therapist can help people with OCD through behavioral and cognitive therapy.  Therapists can help patients with OCD by addressing their fears and limiting compulsive behaviors through intervention techniques or procedures.

Exposure and Response Prevention – This is a type of behavioral therapy where the therapist helps the patient face situations that bring out their fear, anxious thoughts and obsessions. The therapist encourages the patient to suppress the need to perform the rituals that normally help the individual control his distress.

For example, a person who is obsessed with germs can be exposed to a surface that he believes is infested with germs like a public telephone. The therapist encourages the patient to use the public phone and not to wash his hands (response prevention) after using it. The person with OCD must be able to withstand high levels of anxiety that can result from the experience. This method can be complimented with medications such as selective seratonin reuptake inhibitors (SSRIs) and antidepressant drugs.

Medications are also used in treatment including drugs that affect the brain chemical serotonin, as well as medications for depression. Proper intervention techniques can help individuals with OCD combat their condition and live productive lives.

Cognitive-behavior therapy – When Exposure and Response Prevention fails, it is often due to the patient's beliefs that his obsessive thoughts are real. The next best approach is cognitive restructuring which involves determining and challenging the cognitive distortions.

Making art out of OCD

A 28-year old Ilocos-based artist named Manuel Cruz-Sollod found a productive way to channel his compulsion to sort thousands of candies by color.  He learned to use the sorted candies as pixels to reconstruct iconic photographs. He might be seen as strange by others but his compulsion has earned him a good reputation in the world of art.

Manuel resist being labelled as OCD in the clinical sense but a doctor who visited the “OCD” art exhibit suggested that he might be.

‘In any case, isn’t there a little OCD in us all? Who doesn’t find themselves jiggling their feet, doodling on scratch paper, re-ordering the stuff on their desks? The desire for creating order out of disorder has a way of infecting even the most ‘normal’ viewer,” said Manuel.

Photos: “Me organizing the tea basket” by , c/o Flickr. Some Rights Reserved / “Mediaeater” by John Manoogian III, c/o Flickr. Some Rights Reserved.

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Rachel Yapchiongco, also known as Rach to her friends, is a Psychology and Marketing Management graduate of De La Salle University.  She took up several units of MBA at the same university.  Rachel is a full-time mom to a charming young boy and married to an entrepreneur with a passion for cooking. She shares parenting experiences and slices of everyday life on her personal blog called Heart of Rachel.